ProblemI could not find a pulse oximeter to check my patient's oxygen saturation. There were none in the equipment cubby which is a section of our breakroom remote from patient care rooms. I wasted a lot of time going from patient room to room until I found one.Suggested Solution -- Define a specific location that is more convenient to the nurses' and pcts' work flowPerson Describing Problem -- Beth Morrison

Root CauseWhy were none available? It is not a supply issue, there are 7 pulse oximeters for the floor. Why could Beth not find a pulse oximeter? None were in the storage area. Why are the oximeters not returned to the storage area? It is in an inconvenient location. Why when the oximeters are used are they not returned to the storage area? In the past we had a locked equipment room that was centrally located. On our new floor Farr 7, we do not have an equipment storage room and have designated a small cubby hole in the staff breakdown to store equipment. It is inconvenient in relation to the work area. Also, it is in the breakroom so sometimes it is difficult to move past staff who are sitting eating a meal.

Solution (after investigation)A cubby hole in the nurses's station is not being used. It's location in very convenient for small equipment storage. Electrical outlets and shelving need to be installed. Once that work is complete, I will apply LEAN principles and outline with black tape and label each area for the specific equipment.

Action Plan (who, what, by when)1. Kathy Hussain met with staff to brainstorm new, convenient location. Complete.2. Kathy worked with her Operations Coordinator Debbie McGrath to discuss needed work. Complete.3. Kathy discussed renovation with her director Jane Foley. Approval given to move forth with project. Complete4. Kathy and Debbie met with Brendon Raftery and Chris Kimball on March 17th to scope the work. Complete.5. Electrician installed 20 electrical outlets. Complete6. Carpentry measured and ordered required shelving.Complete7. Currently awaiting installation of shelving.8. Once shelving installed- will outline placement of equipment so that each piece of equipment has a designated and corresponding location.

CommentsBeth- thank you so much for calling out this problem. Your willingness to discuss this has lead to more efficiency and less wasted time. As a side benefit, the relocation of the equipment will allow us to recapture space in the breakroom, relieving the crowding and giving the Farr 7 staff a more pleasant breakroom.- Kathy

This is one of those times when you have to discount comments that come in anonymously. We'll just have to surmise what agenda these commentors have.

The issue is not about saving one nurse three minutes. It is about saving many, many nurses time so that they actually spend more time with patients.

Process improvement best occurs when you show respect to the needs of the staff and to their judgment as to what is important. Hospitals have been notoriously slow in realizing this and adopting these techniques. Other industries have been doing it for years.

Anon 2:13pm... But can you imganine 3 minutes out of every hour of every day add up to how much time lost every day? And that is just for one nurse. If 10 nurses each lose 3 minutes, that is 30 minutes an hour, or 4 manhours lost daily (assuming an 8hr work day). This time is paid by the hospital but did not help the patient at all. If patients are to benefit, then every single minute should be used for their benefit directly or indirectly. Not running around looking for things!

Those three min could have been used talking to the patient, or arranging the patient's room, or charting, or better yet, for the nurse to relax in readiness for going into another room. Instead, they were wasted...

Anon 2:11: You may believe this program is the laughing stock of BIDMC but I can tell you from the perspective of a local hospital we are envious of the commitment your CEO has made to hear, respond and take action to his employees concerns. No matter how petty you may think the issue is he has still put it at the top of his list and put an action plan in place. Keep up the good work Paul!

Laughing Stock? No, SPIRIT is empowering. A few months ago, my nurses would have continued to waste time, run around, fetching, searching, room to room for a piece of equipment needed to care for their patient. Pulse oximetry measures the oxygen level in a patient. If you were having difficulty breathing, would you want to wait for a needed assessment while your nurse "wasted 3 minutes" looking for the equipment. I think not. I know I would not want my mother, father, sister, husband to wait. Each nurse on Farr 7 strives to care for every patient as if they were a member of their own family. As manager, if I can do anything to help and get care to the patient sooner while making the nurses job easier, that's Power!

So, no, please, do not laugh at those who have used SPIRIT in the SPIRIT with which this program was intended.

Try it, real time problem solving, not just hit and run complaints; you might just like it.

Special thanks to Samantha and Anisa who are Northeastern University Co-op industrial engineering students who worked with the Farr 7 team to teach us LEAN principles to improve our work lives.

A year ago, my husband, in a hospital in Tulsa, waited for over 24 hours for a pulse ox to be found. (not a spot check, but a full time monitor) while the nurse 'couldn't find one'.

When a Case Manager showed up at his door (who in reality was a friend from church coming to visit, not coming to case manage *BIG GRIN*) the nurse walked into the room across the hall from my husbands room and MAGICALLY walked out with a bedside monitor. She "FOUND ONE!" it magically showed up ...from the Respiratory Supply closet.

I was sooo annoyed (as was the case manager). She said that there were supposed to be measures like the ones you have in place to make sure things like this did not happen.

The rest of his visit went without staff incident. Which, considering he got out 43 days later, and he'd already been in for 2 ...was quite remarkable ... This was, the only incident in that 45 day stay.

I am assuming anon 211 and 213 are the same employee of BIDMC. This comment represents a "call-out" in my opinion - that your process of education in the principles of SPIRIT is incomplete. (There must be others like him/her.) Perhaps this should be examined as an "incident" like the others, lest the project be gradually undermined among the staff by those who don't understand its purpose. Again, examining the system, not blaming the commenter. (BTW, Paul, I thought your response was excellent, but perhaps insufficient to address the implications of this "incident")

Paul, I see where your going with this but my biggest question on this pulse ox issue a more systematic issue then just saving time for nurses. If they are not taking the time to put them back where they should go what else are they not doing? Are they remembering to wipe them down? Are they having issues with other equipment or supplies (IV Pumps, Supplies, etc.)?

Or did you benchmark other departments and other "Best Practice" hospitals to see how they are handling their pulse oximeter usage? Why reinvent the wheel here right?

Paul, what I am saying is that if your are going to solve a problem for one nursing unit, why not ask the questions 1) Are other nursing units having this issue? Is this a hospital wide issue (scope)? 2)Who is not having an issue with managing oxisensors and lets model their success and customer satisfaction.

I mean come on, if this was an infection control type issue would you not check with the other departments?

Also, while you are SPIRIT-ing (I applaud your having a system like this by the way) you should do what I call a 360 degree test which would be to quickly ascertain whether there could be a bigger issue than oxisensor's. It's worth the extra hour or two to find out, no more no less. If not, at least you can document and rest assure there was not.

As far as your definition of benchmarking, it does not always have to be that difficult to pick up the phone with some other (sister or peer) hospitals to see how they manage their pulse oxisensors? Plus I assume you want your SPIRIT assessment should be thorough and not have people punch holes in it before or after the assessment (or worse implementation) is done.